Evidence-based Research Of Acupuncture In Treatment Of Migraine

Objectives:1)To analyze the development status and hotspots of acupuncture for migraine.2)To investigate the reporting quality and risk of bias of randomized controlled trials（RCTs）of acupuncture for migraine,to facilitate and improve the overall quality of RCTs of acupuncture for migraine.3)To overview the systematic reviews/meta-analyses（SRs/MAs）of acupuncture in the treatment of migraine.4)The effectiveness of acupuncture for improving migraine symptoms.Methods:1)Using the bibliometric methods,Web of Science and CNKI were searched from inception to January 2020.Excel 2016 and VOSviewer 1.6.10 were used to analyze the publication year,frequency of citations,authors,countries/regions,institutions,keyword distribution,etc.2)PubMed,Embase,The Cochrane Library CBM,CNKI,VIP,and WanFang were searched from inception to September 2019.The reporting quality and risk of bias of included RCTs were independently evaluated by two investigators using STRICTA and RoB.Any disagreement was resolved by consulting a third investigator.3)PubMed,Embase,The Cochrane Library,CBM,CNKI,VIP,and WanFang were searched from inception to September 2019.Two independent reviewers selected studies and extracted data according to inclusion criteria.PRISMA checklist and the AMSTAR tool were used to evaluate the reporting and methodological qualities of the included studies.4)PubMed,Embase,The Cochrane Library,CBM,CNKI,VIP,and WanFang were searched from inception to September 2019.Two independent reviewers selected studies according to inclusion criteria,extracted data,and assessed the quality of included studies,Review manager5.2 software was used for Meta-analyses.Results:1)A total of 1,532 articles were included,of which 422 were from the Web of Science database and 1,110 from the CNKI.After the 1990s,the number of publications on acupuncture for migraine was increasing.The United States is the country with the largest number of English-language publications and the highest frequency of citations.Although the number of English-language publications ranks second in China,the frequency of citations is lower than in Germany and the United Kingdom.The main organizations are Munich University of Technology,Beijing University of Chinese Medicine,and Chengdu University of Chinese Medicine.The English keywords with the highest frequency of occurrence are acupuncture,migraine,and headache,Chinese keywords are migraine,acupuncture,acupoint injection.2)A total of 67 studies were included.The items with a higher reporting rate based on STRICTA guidelines included:“style of acupuncture”（66/67,99%）,“names of point”（60/67,90%）,and“needle stimulation type”（62/67,93%）,“a precise description of the control or comparator”（65/67,97%）and“number of treatment sessions”（54/67,81%）.Based on RoB,the result showed that 48 articles（72%）provided random sequence generation,23 articles（34%）fully reported allocation concealment using closed opaque envelopes,and 29 articles（43%）fully reported blinding methods,64articles（96%）reported no dropout,67 articles（100%）reported all outcome and 67articles（100%）were not reported other sources of bias.3)19 systematic reviews/meta-analyses（SRs/MAs）were included.The PRISMA checklist score ranges from 14 to 25.The items with lower report quality are“protocol and registration”（16%）,“search”（32%）,“method-additional analysis”（37%）,“result-additional analysis”（26%）,and“summary of evidence strength”（11%）.The score of the AMSTAR is14 articles^{[1,52-58,60-62,63,64,67]}with a score of 5-8 and the methodological quality is medium.One article^[59]scored less than 5,which was of low methodological quality.4)22 RCTs involving2684 patients were included.The results of Meta-analysis showed that acupuncture can effectively reduce the frequency of migraine compared with placebo acupuncture（SMD=-1.00,95%CI-1.47 to-0.54,P<0.0001）and medicine group（SMD=-2.26,95%CI-3.15 to-1.36,P<0.000 01）.Acupuncture can shorten duration of headache compared with placebo acupuncture（SMD=-0.73,95%CI-1.12 to-0.35,P=0.0002）and medicine group（SMD=-1.66,95%CI-2.42 to-0.90,P<0.000 1）.Compared with placebo acupuncture,acupuncture（SMD=-0.67,95%CI-1.15 to-0.19,P=0.006）can relieve headache intensity.The acupuncture group was superior to the placebo acupuncture group（SMD=-10.99,95%CI-16.62 to-5.36,P=0.000 1）and medicine group（SMD=-0.53,95%CI-0.70 to-0.36,P<0.000 01）in improving the cerebral blood flow velocity.Conclusion:1)The publication on acupuncture for migraine has grown rapidly in the past 20 years.The United States has the largest English-language publications and the highest quality,although the number of English-language publications is second in China,the quality of these studies needs to be further improved,the hotspots are acupuncture,acupoint injection,electro-acupuncture,etc.2)The overall quality of acupuncture for migraine RCT is poor,especially in research design,allocation concealment,blind implementation,and standardized reporting.3)The reporting and methodological quality of SRs/MAs of acupuncture in the treatment of migraine are generally moderate,which suggests that further improvements need to be made in research registration,program design,systematic comprehensive literature search,and standardized reporting.4)The present study indicates that acupuncture can effectively reduce the frequency of migraine,shorten the duration of migraine,relieve the intensity of migraine,and improve cerebral blood flow velocity.However,because the quality of the included studies is not high,the conclusion of this study needs further verification.